Since their discovery in the late 1920s, antibiotics and antimicrobial drugs, like amoxicillin, have been vital in human and animal healthcare. These powerful drugs enabled us to treat previously fatal infections, like tuberculosis and pneumonia. These products are used in most surgeries as well as in cancer and HIV treatment.
At the same time, antimicrobials have become one of the most misused medicines. There are countries where antimicrobials are available over the counter without prescription and some people use them to treat common cold.
Antimicrobials are also routinely used by farmers for animal growth promotion and higher farm efficiency. In many low- and middle-income countries, regulations regarding the use of antimicrobials are poor or non-existent. As a result, pathogenic bacteria that cause infectious diseases have started to adapt and have become resistant.
Antimicrobial resistance could “create a much bigger crisis than financial breakdown of 2008” according to Karolina Skog, the Swedish Minister for Environment. Preventing the spread of resistant bacteria is everybody’s problem because unless something is done to tackle it, it could send our healthcare back to the dark ages.
During World Water Week 2017, SIANI and SIWI gathered major stakeholders from different sectors to discuss challenges and solutions to antimicrobial resistance (also known as AMR). Among the speakers were such experts as Peter Hurst, who has significant experience with occupational health and safety in agriculture, Rosemary Kumwenda from the UNDP, Steven Meszaros from Pfizer, Anna Zorzet, representing ReAct and Maria-Teresa Bejarano from Sida. All describing their side of the issue and explaining what people working in different sectors can do to reduce antimicrobial resistance.
The WHO reports that every year 480 000 people globally develop multi-drug resistant tuberculosis, and that drug resistance is starting to complicate the fight against HIV and malaria too. AMR will impede several Sustainable Development Goals, water and health the most.
“Today one new-born child dies every 5 minutes from resistant blood infections!” says Anna Zorzet (ReAct). In fact, according to Carl Frederik Flach (University of Gothenburg) there are places where concentration of antimicrobials in water is higher than in the blood of patients treated with these medicines. A lack of transparency and traceability in pharmaceutical supply chains does not make things better either.
Unfortunately, experts conclude that antimicrobial resistance cannot be solved. However, it can be managed through more restrictive and targeted use of antimicrobials in human and veterinary medicine as well as in farming and through better waste water treatment. These technical solutions must be complemented by a package of social measures, as Juan Lubroth (FAO) points out “this issue is not merely medical, it is about communication”. So, it is essential to raise awareness and provide access to knowledge as well as to create effective cross-sector collaborations.
In many ways, through its waste water discharge the pharmaceutical industry is the major contributor to the evolution of antimicrobial resistance and regulating emissions from manufactures can be very powerful. Carl Fredrik Flach (Univeristy of Gothenburg) commented “the first thing to do is to establish a limit for discharges”. Such legislative measure can make a difference on a large scale, according to Kia Salin (Swedish Medical Products Agency).
Development agencies and foundations can contribute by mainstreaming AMR into all programmes and projects that deal with health, agriculture and sustainable consumption. “We need to invest more in research on behaviour of people who use antimicrobials and in the development of new antibiotics and their alternatives” says Maria-Teresa Bejarano (Sida).
There is enough scientific evidence on AMR to declare it an issue for urgent concern. Indeed, it is recognized at the global level too – in September, 2016 the UN General Assembly adopted the declaration on antimicrobial resistance. Even after this, according to Adela Maghear (Health Care Without Harm) there is still little action. She suggests healthcare workers can become anti-AMR champions by introducing environmental criteria into procurement, buying drugs only from suppliers with low emissions. “Doctors have to insist the industry cleans up its supply chain” says Adela Maghear.
Finally, those most at risk are the estimated 1.5 billion people who work in agriculture, aquaculture and with food processing, such as in slaughter houses. They are at direct risk of catching an antimicrobial resistant disease. “What is more, agricultural workers can also act as carriers of such diseases, showing no symptoms themselves, while passing resistance to others through the food they work with or even simply through a handshake,” says Peter Hurst. According to him, controlling antimicrobial resistance in workplaces through a data-based approach would be another way to combat the AMR challenge.
Antimicrobial resistance spreads across health, water and food boundaries. It is an issue of planetary health with multiple entry points. Sorting the AMR challenge out will require cross-sector partnerships, transparency from the industry and an enormous awareness raising effort because we all need to realise that antibiotics are to be treated with great care. The stakes of inaction are high – our healthcare is on the line.